Prevalence and Characteristics of Pneumonitis Following Irradiation of Breast Cancer

Werner, Elisa; EGGERT, MARIE C.; Bohnet, Sabine; Rades, Dirk

doi:10.21873/anticanres.13847

Cited by 25 publications

(19 citation statements)

References 20 publications

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“…The rate of symptomatic (i.e. grade 2 or higher) radiation pneumonitis in KATHERINE (1.3%) was consistent with the symptomatic radiation pneumonitis incidence of approximately 1%-4% reported with radiotherapy and other systemic therapies for breast cancer, 17,18 with rates varying by radiation dose and fractionation schedule, the way in which the radiation was applied, and prior exposure to other cancer therapies. 18 In KATHERINE, there was a numerically higher incidence of CNS recurrence as the first IDFS event in the T-DM1 versus the trastuzumab arm.…”

Section: Discussionsupporting

confidence: 72%

Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE

et al. 2021

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Background: In the KATHERINE study (NCT01772472), patients with residual invasive early breast cancer (EBC) after neoadjuvant chemotherapy (NACT) plus human epidermal growth factor receptor 2 (HER2)-targeted therapy had a 50% reduction in risk of recurrence or death with adjuvant trastuzumab emtansine (T-DM1) versus trastuzumab. Here, we present additional exploratory safety and efficacy analyses. Patients and methods: KATHERINE enrolled HER2-positive EBC patients with residual invasive disease in the breast/ axilla at surgery after NACT containing a taxane (AE anthracycline, AE platinum) and trastuzumab (AE pertuzumab). Patients were randomized to adjuvant T-DM1 (n ¼ 743) or trastuzumab (n ¼ 743) for 14 cycles. The primary endpoint was invasive disease-free survival (IDFS). Results: The incidence of peripheral neuropathy (PN) was similar regardless of neoadjuvant taxane type. Irrespective of treatment arm, baseline PN was associated with longer PN duration (median, 105-109 days longer) and lower resolution rate (w65% versus w82%). Prior platinum therapy was associated with more grade 3-4 thrombocytopenia in the T-DM1 arm (13.5% versus 3.8%), but there was no grade !3 hemorrhage in these patients. Risk of recurrence or death was decreased with T-DM1 versus trastuzumab in patients who received anthracycline-based NACT [hazard ratio (HR) ¼ 0.51; 95% confidence interval (CI): 0.38-0.67], non-anthracycline-based NACT (HR ¼ 0.43; 95% CI: 0.22-0.82), presented with cT1, cN0 tumors (0 versus 6 IDFS events), or had particularly high-risk tumors (HRs ranged from 0.43 to 0.72). The central nervous system (CNS) was more often the site of first recurrence in the T-DM1 arm (5.9% versus 4.3%), but T-DM1 was not associated with a difference in overall risk of CNS recurrence. Conclusions: T-DM1 provides clinical benefit across patient subgroups, including small tumors and particularly high-risk tumors and does not increase the overall risk of CNS recurrence. NACT type had a minimal impact on safety.

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Section: Discussionsupporting

confidence: 72%

Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE

et al. 2021

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“…Treatment protocols of patients with primary breast cancer most often include radiotherapy following breast-conserving surgery or mastectomy (2). Radiotherapy for breast cancer can be associated with acute and late toxicities (19)(20)(21). Being scheduled for radiotherapy may cause psychological distress that can lead to significant sleep disorders.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Rades

Narvaez

Schild

et al. 2021

In Vivo

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Background/Aim: The anticipation of radiotherapy can cause distress and sleep disorders, which may be aggravated by the COVID-19 pandemic. This study investigated sleep disorders in a large cohort of patients with breast cancer before and during the pandemic. Patients and Methods: Twenty-three characteristics were retrospectively analyzed for associations with pre-radiotherapy sleep disorders in 338 patients. Moreover, 163 patients presenting before and 175 patients presenting during the COVID-19 pandemic were compared for sleep disorders. Results: Sleep disorders were significantly associated with age ≤60 years (p=0.006); high distress score (p<0.0001); more emotional (p<0.0001), physical (p<0.0001) or practical (p<0.0001) problems; psycho-oncological need (p<0.0001); invasive cancer (p=0.003); chemotherapy (p<0.001); and hormonal therapy (p=0.006). Sleep disorders were similarly common in both groups (prior to vs. during the pandemic: 40% vs. 45%, p=0.38). Conclusion: Although additional significant risk factors for sleep disorders were identified, the COVID-19 pandemic appeared to have no significant impact on sleep disorders in patients scheduled for irradiation of breast cancer.Breast cancer is one of the most common cancer types worldwide (1). In the vast majority of patients with primary breast cancer, the treatment regimen includes adjuvant radiotherapy (2). Being scheduled for radiotherapy can cause significant distress for patients, which may be associated with sleep disorders. According to previous studies, sleep disorders are quite common in patients with breast cancer (3,4).Controversy exists regarding the point in time during a patient's course when sleep orders are most prevalent. In a study that investigated sleeping habits in 33 patients with breast cancer and 23 with prostate cancer during a course of radiotherapy plus 6-month follow-up, sleep disorders occurred mainly before and at the beginning of the treatment (5). In a population-based epidemiological study including 465 patients with breast cancer and 263 with prostate cancer, sleep disorders increased during the period of treatment due to radiationrelated side-effects (6). To date, only a few studies have investigated the prevalence of pre-radiotherapy sleep disorders and corresponding risk factors (4, 7, 8). Therefore, a major goal of the current study was the identification of additional risk factors for pre-radiotherapy sleep disorders in a large cohort of patients with primary breast cancer.Distress and pre-radiotherapy sleep disorders may be aggravated by the Coronavirus Disease 2019 (COVID-19) pandemic. The majority of patients with cancer belong to the high-risk group because of immuno-suppression due to malignant disease or anticancer treatment (9-12). The studies reported so far have provided conflicting results regarding the impact of the COVID-19 pandemic on distress and sleep disorders in patients with cancer (13)(14)(15)(16)(17). No study has particularly focused on the impact of the COVID-19 pandemic on the prevalence of slee...

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“…This is because pneumonia is a common and a serious complication after radiotherapy for breast cancer (52). Severe radiation pneumonia has been reported to have a negative impact on the survival of breast cancer patients who had undergone radiotherapy (53). In this analysis, there was no statistically significant difference in pneumonia between the HFRT and CFRT groups.…”

Section: Discussionmentioning

confidence: 64%

Comparing Hypofractionated With Conventional Fractionated Radiotherapy After Breast-Conserving Surgery for Early Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

Dai²,

Fu³

et al. 2021

Front. Oncol.

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BackgroundThe purpose of this meta-analysis was to compare the safety and efficacy between hypofractionated and conventional fractionation radiotherapy in patients with early-stage breast cancer after breast-conserving surgery.MethodsWe conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) published before February 2021. At the same time, the hazard ratio (HR), risk ratio (RR), and 95% confidence interval (CI) were calculated to evaluate local recurrence (LR), relapse-free survival (RFS), overall survival (OS), adverse events, and cosmetic outcomes.ResultsA total of 14 articles were included in this meta-analysis. Four thousand eight hundred and sixty-nine patients were randomly assigned to the control group to receive conventional radiotherapy (CFRT); 6,072 patients were randomly assigned to the experimental group and treated with hypofractionated radiotherapy (HFRT). The results showed that there was no statistical difference between HFRT and CFRT in LR (HR = 0.99, 95%CI = 0.97–1.02, p = 0.476), RFS (HR = 0.99, 95%CI = 0.97–1.02, p = 0.485), OS (HR = 1.00, 95%CI = 0.97–1.03, p = 0.879), and cosmetic outcomes (RR = 1.03, 95%CI = 0.95–1.12, p = 0.53). In addition, HFRT showed fewer severe adverse reactions such as acute skin toxicity, induration, breast atrophy, and pain.ConclusionOur results suggest that there is no statistical difference between HFRT and CFRT in terms of LR, RFS, OS, and cosmetic outcomes. HFRT reduces the risk of developing toxicity reactions compared to CFRT. HFRT may be a better option for patients with early breast cancer after breast-conserving surgery.

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Prevalence and Characteristics of Pneumonitis Following Irradiation of Breast Cancer

Cited by 25 publications

References 20 publications

Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE

Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Comparing Hypofractionated With Conventional Fractionated Radiotherapy After Breast-Conserving Surgery for Early Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

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